A SUCCESSFUL CASE OF HYDROTHORAX. 
147 
about 76, and oppressed ; there was a general disinclination for 
food and motion of any kind, and his legs appeared as groggy as 
if he had lost their use entirely. Six or seven quarts of blood were 
abstracted, and then a fever ball administered every three hours. 
About three or four hours after bleeding the respiration became 
more natural. 
On the 6th, and following day, the pulse was 85, but weak ; 
there was greater languor than on the preceding day ; the 
legs very cold ; the conjunctiva had changed from its vascular 
hue to that of a yellowish shade. As the pulse was so weakly 
and indistinct, I did not feel myself justified in abstracting more 
blood, but continued the febrifuge medicine until the bowels were 
brought into a lax state. 
Nearly the same symptoms and treatment were continued un- 
til the 12th, excepting that the pulse was quicker and less dis- 
tinct, and the disinclination for food still remained. 
At this stage of the case 1 felt quite confident that effusion to a 
great extent had taken place within the thorax, and, consequent- 
ly, that recourse must be had to the operation of paracentesis, if 
life was intended to be saved. Accordingly, the trocar was in- 
troduced into the near side, care being taken to prevent the ex- 
ternal air from entering into the cavity of the chest ; but no fluid 
was found. The off side was then operated upon in a similar 
way, and about six quarts of watery fluid' came away in a full 
stream. As soon as the stream had ceased to flow, the tube of the 
trocar was withdrawn, and the orifice neatly and securely covered 
by a small pitch plaister. 
About a couple of hours after the operation, respiration seemed 
considerably easier, and for the first time in seven days a little 
mash, with a few carrots, were eaten with an apparent appetite. 
After this, I must confess that I deviated no little from the ordi- 
nary and even my own accustomed mode of treatment in such 
cases ; for, instead of adopting the usual tonic system, I proceeded 
upon the following course: — I gave 3j of hydrar. submur., com- 
bined with a diuretic, morning and evening. The sides were 
close shaven, and ^viij ungent. hydr. fort., combined with Jij of 
hydriod. pot., was well rubbed in, until a slight salivation was 
produced. The hydrarg. submur. was then discontinued, and 
only a gentle diuretic given. 
On the L4th, four more quarts of fluid were abstracted ; and on 
the 18th rather more than three quarts came away ; and the drain- 
ing seemed now complete, for no more fluid could be abstracted. 
From this time a gradual but manifest improvement took place. 
From the 18th to the 22d gentle diuretics continued to be 
given. 
